REVISED
ALAMEDA COUNTY
HEALTH CARE SERVICES
AGENCY
REBECCA GEBHART, Acting Director
Agenda _____ May 10, 2016
ADMINISTRATION & INDIGENT HEALTH
1000 San Leandro Boulevard, Suite 300
San Leandro, CA 94577
TEL (510) 618-3452
FAX (510) 351-1367
April 20, 2016
REVISED
The Honorable Board of Supervisors
County Administration Building
1221 Oak Street
Oakland, Ca 94612
Dear Board Members:
SUBJECT: ACCEPT THE SUBMISSION OF ANNUAL REPORTS FOR ALAMEDA COUNTY EMERGENCY
MEDICAL SERVICES DISTRICT AND REFER THE ITEM TO YOUR BOARD’S JUNE 2016
COUNTY BUDGET HEARINGS FOR CONSIDERATION AND ADOPTION OF SERVICE
CHARGES FOR FISCAL YEAR 2016-2017
RECOMMENDATIONS
A. Accept the submission of the Annual Reports outlining the Fiscal Year 2016-2017 proposed
budget for the Alameda County Emergency Medical Services District, which includes a
proposed 3.02% increase to the annual district special rate; the rate of $30.68 per benefit
unit is proposed based on the February 2016 year-on-year change in the San FranciscoOakland-San Jose Consumer Price Index for All Urban Consumers released by the Bureau of
Labor Statistics; and
B. Refer this item to your Board’s June 2016 Fiscal Year 2016-2017 County Budget Hearings for
consideration of the Annual Reports and adoption of service charges for Fiscal Year 20162017
SUMMARY
The Alameda County Health Care Services Agency (HCSA) requests that your Board review the
Annual Reports and adopt the proposed service charges at your Board’s June 2016 Fiscal Year
2016-2017 County Budget Hearings. On June 30, 2015, your Board approved a new special tax
rate of $29.78 per benefit unit for Fiscal Year 2015-2016. Due to cost-of-living increases and use
of available fund balance, it is projected that Alameda County Emergency Medical Services
(EMS) will not be able to maintain its current services in future years at the current tax rate.
Hence, it is recommended that an adjusted tax rate of $30.68 (an increase of $.90) be adopted
for Fiscal Year 2016-2017. The proposed 3.02% increase is based on the February 2016 San
Francisco-Oakland-San Jose area CPI increase data released by the Bureau of Labor Statistics.
County Service Area EM-1983-1
Budget Unit 450111
ANNUAL REPORT
FY 2016-17
Proposed Budget
Salaries & Benefits
Services & Supplies
Trauma Care*
First Responder Services Unit
Dispatch Centers
Professional and Specialized Services Contract
Operating Expenses
Total Services & Supplies
Indirect Costs
Fixed Assets
Total Proposed Budget
$
4,252,818 (Ref 1)
$ 9,246,343
$ 4,787,483
$ 3,281,915
$ 200,000
$ 3,297,483
$ 20,813,224
$
155,676
$
$ 25,221,718 (Ref 2)
$ 25,221,718
$
$
$
FY 15/16 Beginning Available Fund Balance -15/16 Expected Use of Available Fund
FY16/17 Use Available Fund Balance Budget
Contingency Reserve from AFB
2,409,440
930,249
1,479,191
(Ref 4)
(Ref 3)
$ 26,700,909
Total District Budget & Reserve
Assessments
$ 18,668,808
Certification Fees
Ambulance Ordinance
Interest Income
$
$
$
Other Revenue (Ambulance Service Provider Pass-thru
Other Revenue
Total Revenue
Use Available Fund Balance
Total Revenue & Use available fund balance
$ 5,332,661
$
130,000
$ 24,291,469
$
930,249
$ 25,221,718
80,000
70,000
10,000
$ 25,221,718
$ 1,479,191
$ 26,700,909
Total Revenue Estimated and AFB
Contingency Reserve from AFB
Total All Revenue/AFB
Calculation of District Special Tax
FY 2015-16 Assessment Rate
Proposed District Rate Increase
(Ref 3)
$29.78
$0.90
$30.68
Benefit Units Per Assessor's Office (FY 15-16)
FY 2015-16 Assessment Rate
Total FY 2015-16 Assessment Amount
Less County Collection Cost (1.7%)
Net Assessment Revenue for District
$
$
$
629,700.00 (Ref 5)
$30.68
19,319,196
(328,426)
(Ref 6)
18,990,770
$
$
$
566,730
(9,634)
557,096
Notes:
1) Ref 1: Funds 30 Full Time Equivalent (FTE) positions
2) Ref 2: Proposed budget per FY 2016-17 MOE Request
3) Ref 3: Contingency Reserve from Available Fund Balance is equal to the total Available Fund Balance less Proposed the used of Available Fund Balance
4) Ref 4: Available Fund Balance is equal to FY 15-16 Beginning Available Fund Balance less FY 15-16 Expected Use of Available Fund Balance
5) Ref 5: Countywide number of benefit units estimated based on FY 15-16 CSA Paramedic tax roll
6) Ref 6: County Treasurer collection cost
* Trauma Care Detail
Alameda Health System
UCSF Benioff Children’s Hospital Oakland
Sutter Eden Medical Center
UCSF Benioff Children's Hospital Oakland ED Pediatric
Readiness
Trauma Care Total
5,266,383
1,982,480
1,982,480
15,000
$ 9,246,343
1 of 1
4/28/2016 8:11 AM
Rebecca Gebhart, Acting Director
ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY
Emergency Medical Services District
Travis Kusman, MPH, Acting EMS Director
Karl Sporer, MD, Medical Director
1000 San Leandro Blvd., Suite 200
San Leandro, CA 94577
Main (510) 618-2050
Fax (510) 618-2099
Alameda County Emergency Medical Services District (CSA EM-1983-1)
Annual Report for Fiscal Year 2015-16
INTRODUCTION
In 1982, Alameda County held a County-wide advisory election asking voters to create a
County Service Area for paramedic services and imposing a benefit assessment. Seventy-nine
percent of the voters approved the measure. County Service Area (CSA) EM-1983-1 was
created in 1983 and included the unincorporated areas and all Alameda County cities except
the City of Alameda which chose not to become a member of the District. In 1989, County
Counsel advised that the Board had discretion to raise the basic assessment to fund the
additional cost of providing trauma services. In 2011, the City of Alameda was annexed into
the District.
Proposition 218, the Right to Vote on Taxes Act, approved by voters in November 1996, placed
new limitations on the ability of counties and other local jurisdictions to raise revenues from
assessments, taxes and fees. County Counsel determined at that time that the EMS
assessment must be replaced with a two-thirds voter approved special tax. A special election
was held in June 1997, and the passage of Measure C at that time re-established the
paramedic benefit assessment as an Emergency Medical Services benefit tax, at a rate of
$21.14 per benefit unit, adjusted annually according to the Consumer Price Index (CPI) for the
San Francisco-Oakland-San Jose Area.
PURPOSE
The purpose of this benefit tax is to provide funding of ambulance, paramedic, trauma care,
dispatch, and related services being provided by the Emergency Medical Services District, which
is administered through the Emergency Medical Services (EMS) division of the Health Care
Services Agency.
EMS provides oversight and quality management of the County’s 911 emergency medical
response system, which includes administration of contracts for ambulance transport and first
responder services. EMS also provides funding and coordinates data analysis and peer review
proceedings for the County’s three trauma centers at Alameda Health System, Eden Medical
Center Castro Valley, and UCSF Benioff Children’s Hospital Oakland. EMS also contracts with the
Alameda County Regional Emergency Communications Center (ACRECC) for dispatch and
medical pre-arrival instructions.
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SCOPE OF SERVICES
The EMS division is designated by the State of California as a Local EMS Agency (LEMSA).
LEMSAs, as defined by Division 2.5 of the Health and Safety Code, have specific duties that
include, but are not limited to:
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Certifying Emergency Medical Technicians and accrediting paramedics to practice in the
county;
Designating and providing oversight to specialty centers, such as trauma, stroke and
cardiac receiving centers;
Developing and submitting the EMS System Plan to the State EMS Authority, including
annual updates;
Providing physician medical direction of the 911 medical response system;
Developing and updating EMS policies and procedures;
Approving and providing oversight to EMS training programs and continuing education
providers;
Overseeing and tracking the implementation of public access defibrillation; and
Planning and responding to natural and manmade disasters.
SERVICE CHARGES
Section 2.20.40 of Chapter 2.20 of Title 2 of the Ordinance Code of the County of Alameda
authorizes your Board to adjust by resolution the tax rate by the amount which the Consumer
Price Index (CPI) for the San Francisco-Oakland-San Jose Area has increased during the
immediately preceding year. The current rate, per benefit unit is $29.78. The proposed Fiscal
Year 2016-2017 benefit tax rate is $30.68, or ninety more cents per benefit unit, based on the
CPI increase of 3.02%.
PROJECTS IN FISCAL YEAR 2015-16
During the fiscal year, EMS worked closely with Paramedics Plus, fire departments, hospitals
and ACRECC to ensure a quality and efficient emergency medical services system. Overall
system compliance remained above contractually obligated minimums. In addition, indicators
of clinical performance continue to be excellent and are above national standards in many
cases. EMS continues to be actively engaged in research in the prehospital setting, influencing
the development and implementation of leading best practices within and well beyond the
borders of the County. Several peer reviewed papers listing the County’s EMS Medical Director
as an author were published in leading journals including Prehospital Emergency Care and the
Western Journal of Emergency Medicine this fiscal year. A Prehospital Care Coordinator (PHCC)
and EMS Fellow were also published this fiscal year in the Journal of Emergency Medical
Services.
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Over the past several years, changes in healthcare financing have substantially impacted the
ambulance service payor mix in the County EMS system. A major shift into Medi-Cal and
Medicare coverage from commercial insurance, coupled with decreased reimbursement rates
by commercial insurers, has resulted in an overall decrease in per-call revenue. In conjunction
with contractually imposed costs, this decline in reimbursement seriously challenged the
financial solvency of Paramedics Plus. This fiscal year, $4,000,000 from the EMS Trust Fund was
provided as a one-time payment to Paramedics Plus to offset losses due to changes in its payor
mix and to stabilize ambulance services in the EMS system. Concurrently, EMS remained
engaged in long-term planning and development of a Request for Proposal designed to ensure
quality emergency medical services well into the future.
During Fiscal Year 2015-16, EMS continued to work closely with fire service first responder and
transport agencies. The use of a common reporting system enabled effective procurement and
analysis of data. Fire department response time compliance was reviewed; every department
was well above required minimum performance measures. EMS also established a “Community
Paramedicine” program in collaboration with the City of Alameda Fire Department and the
California Emergency Medical Services Authority; this county was one of thirteen sites chosen
statewide for a pilot project.
The EMS Corps program continued to provide enhanced life coaching and other services in
addition to Emergency Medical Technician (EMT) training. This year, Prehospital Care
Coordinators actively engaged with the EMS Corps program, serving both as primary EMT
curriculum instructors and mentors. Graduates of the program continue to pass the National
Registry examination with a high success rate, with many obtaining and retaining employment
with local ambulance providers. Graduates are also working in other healthcare environments,
including a Health Coaching program also coordinated by EMS. The Robert Wood Johnson
Foundation was a major supporter of the Health Coach program.
Prehospital Care Coordinators continued to manage programs in cardiovascular care including
cardiopulmonary resuscitation (CPR) training and the placement of automatic external
defibrillators (AEDs) in the community. In addition, they oversaw or managed trauma care,
unusual occurrence investigations, quality improvement and clinical measurements,
certification investigations and processing, the ambulance ordinance, helicopter utilization,
contract compliance, EMS for children, disaster planning, and EMS tactical medicine.
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